Which of the following is seen in Seropositive Rheumatoid Arthritis?

(D) All of the above[?]Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology marked by a symmetric, peripheral polyarthritis.It is the most common form of chronic inflammatory arthritis & often results in joint damage and physical disability.Because it is a systemic disease, RA may result in a variety of extraarticular manifestations, including fatigue, subcutaneous nodules, lung involvement, pericarditis, peripheral neuropathy, vasculitis & hematologic abnormalities. Rheumatoid Arthritis Criteria (1987 revision, American Rheumatism Association):Morning stiffness (in/around joints, >1 hr before maximal improvement)Arthritis (swelling) of 3 or more joint areas (observed by physician)Symmetric arthritis (swelling, NOT bony overgrowth)Arthritis of Hand joints (wrists, MCPs or PIPs)Rheumatoid nodulesRheumatoid factor (serum)Radiographic changes (erosions and/or peri-articular osteopenia in hand/wrist joints)Requirements: >4 of the above 7 criteria. Criteria 1-4 must have been present for at least 6 weeks.Characteristic hand signs:Z-thumbs, Boutonniere, swan-necking, ulnar deviation, muscle wasting, subluxation of MCP, sometimes Carpal tunnel syndrome, Atlantoaxial subluxationExtra-articular features; Sjogren 'ds syndrome, Reynaud's, vasculitis. Nodules (firm but usually painless)Pathology: Auto-antibody production (70%IgM,30%IgG) against joint tissues.Investigations:Blood: RA factor positive. Rheumatoid factor is not diagnostic. Present in 70%, but also in general population. Rheumatoid positive disease has worse prognosis and more extensive deformity. Anti-CCP antibodies test similar to rheumatoid factor, | ESR + | CRP, normochromic-normocytic anaemia common.X-ray: look for nodules, soft-tissue swelling, osteopaenia, deformity, erosions.Treatment:Aim to reduce long-term deformity & LoF. Steroids induce remission, beware SE's long termDMARDs are mainstay. All can cause myelosuppression and rash plus: Sulfasalzine: hepatic impairment, oligospermia, methotrexate; GI disturbance (give folic acid to reduce), mouth ulcers, hepatic impairment gold; medical emergency rash, photosensitivity, nephrotic syndrome; leflunomide, chloroquine: retinitis, tinnitus, infliximab; anti TNF- a agent: can cause reactivation of latent diseases (e.g. TB).